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Table of Contents    
Year : 2018  |  Volume : 66  |  Issue : 6  |  Page : 1857-1858

Dos and Don'ts of virtual reality-based simulators for cranial tumor surgery

1 Department of Neurosurgery, University Hospital Sofiamed, Sofia, Bulgaria
2 Department of Neurosurgery, University of Al-Qadisiyah, Medicine College, Diwaniyah, Iraq
3 Department of Neurosurgery, College of Medicine, Baghdad University, Iraq
4 Department of Neurosurgery, Neurosurgery Teaching Hospital, Baghdad, Iraq
5 Department of Neurosurgery, Universidad Nacional Autonoma de Nicaragua, Managua, Nicaragua
6 Department of Neurosurgery, Neurosciences Centre, AIIMS, New Delhi, India
7 Department of Neurosurgery, Universidad de Cartagena, Cartagena, Colombia

Date of Web Publication28-Nov-2018

Correspondence Address:
Dr. Luis Rafael Moscote-Salazar
Cartagena Neurotrauma Research Group, Universidad de Cartagena, Cartagena
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0028-3886.246244

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How to cite this article:
Dimitrov A, Dolachee AA, AbdulAzeez MM, Hoz SS, Narvaez-Rojas A, Satyarthee GD, Moscote-Salazar LR. Dos and Don'ts of virtual reality-based simulators for cranial tumor surgery. Neurol India 2018;66:1857-8

How to cite this URL:
Dimitrov A, Dolachee AA, AbdulAzeez MM, Hoz SS, Narvaez-Rojas A, Satyarthee GD, Moscote-Salazar LR. Dos and Don'ts of virtual reality-based simulators for cranial tumor surgery. Neurol India [serial online] 2018 [cited 2022 May 26];66:1857-8. Available from: https://www.neurologyindia.com/text.asp?2018/66/6/1857/246244


The massive expansion of new technology, particularly within the software industry has revolutionized medicine and is now intertwined into every part of it, leading to the introduction of groundbreaking modalities for the training and planning of surgical procedures. Virtual reality (VR) offers a unique experience as it can provide very realistic feedback without risking patients’ safety. Like every new technology, VR is an expensive tool, but when compared to the traditional training models, it has been rendering superior outcomes, as a long-term training alternative.[1] VR has immense implications for education but also has its downsides, i.e., simulations cannot accurately and fully present the experience that surgeons have in the operating room. Alotaibi et al., have noted the lack of connection between what is learned on the simulator and a measurable performance in the operating room.[2] Hoolloway et al., have found that residents did not demonstrate improvement after a baseline proficiency has been attained.[3]

Similarly, while using a simulator, it is hard to comprehend and simulate all the complications that could occur during a real surgery, such as profuse bleeding and brain swelling. Therefore, it is necessary to consider introducing effective modalities of VR that adds complications to the surgeries simulated.

Al Zhrani et al., have tried to establish some limitations that are fundamental to the use of VR. A major one was a wide range of variations in the proficiency that attending neurosurgeons demonstrated.[4] Further measurements that use diverse skill sets are needed to refine these benchmarks and to avoid confounding variations in the results. Unfortunately, all the five studies that included a user evaluation and a simulator validation were taken in one facility only (the Montreal Neurological Institute and Hospital at McGill University). A new multicenter study that assesses the effectiveness of training on resident performance within the VR set up will reveal weaknesses and strengths as well as add insights and directions for future development. Despite the weaknesses discussed above, all five studies have shown high Medical Education Research Study Quality Instrument scores, which has proven that they are very likely to be reproducible. Vapenstad et al., and Lee et al., were cautious about these new technologies.[5],[6] According to them, we stand up for the statement that mentorship is an unreplaceable part of the training process and the relationship between the mentor and the mentee could not be replaced by any technology. The human factor must always be presented. The experience that professors could transfer to their trainees is unmeasurable. It is unlikely that VR would fully replace the real-time, hands-on training, which is integral to every surgical training program.

Thus, these new emerging technologies can help young doctors (especially residents) and medical students willing to join neurosurgery to advance more rapidly in the field without compromising patient safety.[3],[7] The comparative study of Holloway et al., pointed out the linear learning curve for medical students who improved and gained practical skills after each successive session, unlike residents who are unlikely to improve substantially.[3]

In the case scenario quite unlike that seen in the training of residents, VR actually assists attending physicians in better planning their operations. Yang et al., evaluated not only surgical but also functional outcomes postoperatively (Karnofsky performance scale and complication frequency) following a VR training session for attending physicians. They concluded that utilizing VR for presurgical planning yielded better outcomes.[8]

Yoshino et al., presented a presurgical planning for cerebellopontine angle meningiomas using VR. In this article, VR was used to demonstrate the most vascularized attachment (MVA) of the lesion. The article revealed the employment of VR as a tool for planning and better orientation during surgery compared to radiological modalities.[9]

Although the VR environment is useful and has helped neurosurgeons to understand the spatial relationships between anatomical structures and adjacent white matter tracts, more refined software is needed to simulate real-world complications that occur during surgery.[10],[11],[12]

VR has the potential to revolutionize presurgical approaches, training, and presurgical planning, but further studies and innovations are needed to integrate VR in its fullest capacity into the field of neurosurgery.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Tan SSY, Sarker SK. Simulation in surgery: A review. Scott Med J 2011;56:104-9.  Back to cited text no. 1
Alotaibi FE, AlZhrani GA, Mullah MAS, Sabbagh AJ, Azarnoush H, Winkler-Schwartz A, et al. Assessing bimanual performance in brain tumor resection with neurotouch, a virtual reality simulator. Neurosurgery 2015;11(Suppl 2):1.  Back to cited text no. 2
Holloway T, Lorsch ZS, Chary MA, Sobotka S, Moore MM, Costa AB, et al. Operator experience determines performance in a simulated computer-based brain tumor resection task. Int J Comput Assist Radiol Surg 2015;10:1853-62.  Back to cited text no. 3
AlZhrani G, Alotaibi F, Azarnoush H, Winkler-Schwartz A, Sabbagh A, Bajunaid K, et al. Proficiency performance benchmarks for removal of simulated brain tumors using a virtual reality simulator NeuroTouch. J Surg Educ 2015;72:685-96.  Back to cited text no. 4
Våpenstad C, Hofstad EF, Bø LE, Kuhry E, Johnsen G, Mårvik R, et al. Lack of transfer of skills after virtual reality simulator training with haptic feedback. Minim Invasive Ther Allied Technol 2017;26:346-54.  Back to cited text no. 5
Lee GI, Lee MR. Can a virtual reality surgical simulation training provide a self-driven and mentor-free skills learning? Investigation of the practical influence of the performance metrics from the virtual reality robotic surgery simulator on the skill learning and associated cognitive workloads. Surg Endosc June 2018;32:62-72.  Back to cited text no. 6
Gélinas-Phaneuf N, Choudhury N, Al-Habib AR, Cabral A, Nadeau E, Mora V, et al. Assessing performance in brain tumor resection using a novel virtual reality simulator. Int J Comput Assist Radiol Surg 2014;9:1-9.  Back to cited text no. 7
Yang DL, Xu QW, Che XM, Wu JS, Sun B. Clinical evaluation and follow-up outcome of presurgical plan by Dextroscope: A prospective controlled study in patients with skull base tumors. Surg Neurol 2009;72:682-9.  Back to cited text no. 8
Yoshino M, Kin T, Nakatomi H, Oyama H, Saito N. Presurgical planning of feeder resection with realistic three-dimensional virtual operation field in patient with cerebellopontine angle meningioma. Acta Neurochir (Wien) 2013;155:1391-9.  Back to cited text no. 9
Suri A, Patra DP, Meena RK. Simulation in neurosurgery: Past, present, and future. Neurol India 2016;64:387-95.  Back to cited text no. 10
[PUBMED]  [Full text]  
Ganapathy K, Abdul SS, Nursetyo AA. Artificial intelligence in neurosciences: A clinician's perspective. Neurol India 2018;66:934-9  Back to cited text no. 11
Qiu T, Zhang Y, Wu J-S, Tang WJ, Zhao Y, Pan ZG, et al. Virtual reality presurgical planning for cerebral gliomas adjacent to motor pathways in an integrated 3-D stereoscopic visualization of structural MRI and DTI tractography. Acta Neurochir (Wien) 2010;152:1847-57.  Back to cited text no. 12

This article has been cited by
1 PubMed-indexed neurosurgical research productivity of Iraq-based neurosurgeons
Samer S. Hoz, Zahraa F. Al-Sharshahi, Ignatius N. Esene, Ali A. Dolachee, Ali M. Neamah, Aktham O. Al-Khafaji, Mohammed A. Al-Dhahir, Hatem Sadik
Surgical Neurology International. 2021; 12: 223
[Pubmed] | [DOI]


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